Medicare Part B

Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by enrollees and by contributions from the federal government.

What is the cost to enrollees?

Premiums

In 2013, the Medicare Part B premium for most people is $104.90. Your monthly premium will be higher if you file an individual income tax return and your modified adjusted gross income (MAGI) is more than $85,000, or if you file a joint income tax return and your MAGI is more than $170,000. These income thresholds will remain the same through 2019.

Deductibles

The Medicare Part B deductible is $147 in 2013 ($140 in 2012).

What does Medicare Part B cover?

Medical care that is not inpatient is usually covered under Medicare Part B. Medicare Part B covers 80 percent of medically necessary physician or outpatient charges, including charges from a physician for care received in a hospital. The Part B deductible generally applies.

Physician and surgeon fees Outpatient services Immunosuppressive drugs Blood service, after you pay for the first three pints of blood in any calendar year Clinical laboratory services Some coverage for outpatient mental health visits Certain medically-necessary home health services Physical and occupational therapy Ambulance service

Medicare also fully covers the cost of most preventive services (beneficiaries will pay nothing out-of-pocket) if a health-care provider accepts Medicare assignments. Some services are limited to one per year. The preventive services Medicare fully covers include:

In general, Medicare pays only for services it considers reasonable or medically necessary. Specific exclusions include:

Cosmetic surgery, unless particular medical conditions render it necessary Procedures considered experimental Hearing aids and fittings Chiropractic services, except for treatment of subluxation (partial dislocation) of the spine Most eyeglasses and eye exams Most dentures and dental care Prescription drugs you administer yourself, such as those you buy at a drug store and take at home (exceptions are immunosuppressive drugs and antirejection drugs for kidney transplant patients) Over-the-counter drugs Care outside of the United States (except when a Mexican or Canadian hospital is closer, such as in an emergency, even though you reside in the United States, or if you require care while traveling through Canada en route to Alaska)

Tip: Prescription drug coverage is available under Medicare Part D (prescription drug coverage).

Caution: Medicare regulations specifying what it will cover almost always begin with a general rule, followed by exceptions. If you are denied coverage, it is always wise to look into whether or not you can meet one of the exceptions.

You can get further information about coverage under Medicare Part B by calling the Social Security Administration at (800) 772-1213 or by visiting www.ssa.gov (the Social Security Administration website) or www.medicare.gov. The Medicare website contains a comprehensive list of covered services, including a preventive care checklist that you can take to your health-care provider to find out which services are right for you.

This website is a private website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Centers for Medicare & Medicaid Services. This site contains basic information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Federal Government's Medicare program, please visit the official U.S. Government's Site for people with Medicare located at www.medicare.gov.